title: Anaphylaxis: incidence, presentation, causes and outcome in patients in a tertiary-care hospital in Karachi, Pakistan.
abstract: BACKGROUND
  Anaphylaxis is a potentially fatal condition requiring immediate resuscitation. Data regarding the epidemiology of anaphylaxis are limited and inconsistent. A reason for the variability was unavailability of a universally acceptable case definition till 2005. We reviewed cases using this new definition
  
  
  OBJECTIVE
  To review the incidence, clinical presentation, cause and outcome of anaphylaxis at a tertiary-care centre in a low-income country.
  
  
  METHODS
  Retrospective, case series
  
  
  METHODS
  Chart review of all patients discharged from Aga Khan University Hospital between January 1988 and December 2012 (24 years) with anaphylaxis definition as per second National Institute of Allergy and Infection disease/Food Allergy and Anaphylaxis Network Symposium
  
  
  RESULTS
  Total of 129 cases were found with mean age of 41.6 years (SD 18.8). Majority of patients had cutaneous features (76.7%), followed by respiratory (68.9%), cardiac (64.3%) and gastrointestinal (20.9%) symptoms, respectively. About 22.4% of patients had positive history for allergens out of which 31% (n = 9) were exposed to the same allergens. The common causes identified for anaphylaxis were drugs (60.5%), food (16.3%) and intravenous contrast (10.9%), respectively. Only 22.5% of cases received epinephrine as a part of their initial management. In four patients (3.1%) the cause of death was attributed to anaphylaxis.
  
  
  CONCLUSIONS
  Anaphylaxis is a rare but life-threatening condition. Though cutaneous features are most common, their absence does not exclude the diagnosis. Drugs were the most common cause and epinephrine was not commonly used as first-line agent for its management.
authors.affiliation: MD, Diplomate American Board of Internal Medicine, Assistant Professor, Department of Emergency Medicine, The Aga Khan University Hospital, P.O. Box # 3500, Stadium Road, Karachi - 74800, Pakistan. nadeemullah.khan@aku.edu.
authors.forename: N U
authors.initials: NU
authors.lastname: Khan
authors.forename: N
authors.initials: N
authors.lastname: Shakeel
authors.forename: A
authors.initials: A
authors.lastname: Makda
authors.forename: A S
authors.initials: AS
authors.lastname: Mallick
authors.forename: M
authors.initials: M
authors.lastname: Ali Memon
authors.forename: S H
authors.initials: SH
authors.lastname: Hashmi
authors.forename: U R
authors.initials: UR
authors.lastname: Khan
authors.forename: J A
authors.initials: JA
authors.lastname: Razzak
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000707:Anaphylaxis / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D004342:Drug Hypersensitivity / Q000150:complications / Q000453:epidemiology; D005260:Female; D005512:Food Hypersensitivity / Q000150:complications / Q000453:epidemiology; D005938:Glucocorticoids / Q000627:therapeutic use; D006634:Histamine H1 Antagonists / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D008875:Middle Aged; D010154:Pakistan / Q000453:epidemiology; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D016896:Treatment Outcome
chemical_list: D005938:Glucocorticoids; D006634:Histamine H1 Antagonists